HomeMy WebLinkAbout09-02-2021 Well & Boring Construction Record WELL OR BORING LOCATION
MINNESOTA DEPARTMENT OF HEALTH MINNESOTAAND BORINGG UE NO.WELL
County Name - – WELL AND BORING CONSTRUCTION RECORD 857012
Minnesota Statutes,chapter 1031
Hennepin
Township Name Township No. Range No. Section No. Fraction(sm.—.Ig.) WELUBORING DEPTH(completed) DATE WORK COMPLETED
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Orono 117 23 07 SE SE N& 134 f. 9/2/21
GPS LOCATION—decimal degrees(to four decimal places). DRILLING METHOD
Latitude Longitude ❑Cable Tool ❑Driven ❑Dual Rotary
❑Auger ®Rotary ❑Rotasonic
House Number,Street Name,City,and ZIP Code of Well Location E ❑Other
4709 Highwood Drive, Orono 55364 DRILLING FLUID WELL HYDROFRACTURED? ❑Yes X No
Show exact location of well/boring in section grid with"X." Sketch map of well/boring location. Bentonite From ft.To ft.
Showing property lines,
N roads,buildings,and direction. USE ®Domestic ❑Monitoring ❑Heating/Cooling
.__:_____ __ ❑Noncommunity PWS ❑Irrigation ❑Industry/Commercial
❑Community PWS ❑Dewatering ❑Remedial
❑Elevator ❑
W' E T CASING MATERIAL Drive Shoe? ❑Yes ❑No HOLE DIAM.
--4,'-----t----F--•- --- I` —L....]
V M ❑Steel ❑Threaded ❑Welded
• Fe mile g Plastic ❑
CASING
S Diameter Weight Specifications �{ ^
1 Mile 4 in.To 125 ft. lbs./ft. 8 in.T 5°`ft.
PROPERTY OWNER'S NAME/COMPANY NAME in.To ft. lbs./ft. 65 in.Tom 3 5 ft.
Creek Hill Ca tom Homes in.To ft. lbs./ft. in.To ft.
SCREEN e$
JOPEN HOLE
Property owner's mailing address if different than well location address indicated above.
Make o neon From • ft. To ft.
w
15235 65th Place, Type stainless Diam. 2 8*
. Maple Grove MN 55311
Slot/Gauze e25 4,15 Length3*
Set between 125 ft.and 1 34 ft. FITTINGS lead
STATIC WATER LEVEL 58 ft.X(Below ❑Above land surface
Date measured 9i 2/21 Dry hole ❑Yes M No
WELL OWNER'S NAME/COMPANY NAME PUMPING LEVEL(below land surface) 2 ,
120 ft.after hrs.pumping 35 g.p.m.
Well/boring owner's mailing address if different than property owner's address indicated above. WELLHEAD COMPLETION y
A Pitless/adapter manufacturer white water Model
❑Casing protection 12 in.above grade
❑At-grade ❑Well House ❑Hand Pump
GROUT INFORMATION(specify bentonite,cement-sand,neat-cement,concrete,cuttings,or other)
Material rut ting$om 125Th 50 ft ❑Yds. ❑Bags
Materialbe n t on i t lwom To —ft. 3 ❑Yds. X Bags
HARDNESS OF Material From To ft. ❑Yds. CIBags
GEOLOGICAL MATERIALS COLOR MATERIAL FROM TO One bag94 lbs.cement
Driven casing seal From To Bags
or 50 lbs.bentonite
` NEAREST KNOWN SOURCE OF CONTAMINATION
Clay
con in 0 33 Well is CI 0 feet direction from . -
type
Well disinfected upon completion? X Yes ❑No
sandy clay gray a 33 46 PUMP
❑Not installed Date installed /3/2l _
fine sand brown = 46 104 Manufacturer's name chafe9r
silty/fine r� Model Number HP 3+ 4 volts
230
clay sand ,gray m 104 12�`y }��j
Length of drop pipe 8 T ft. Capacity / g.p.m
sand/gravel mix s 122 135 Type: Submersible ❑L.S.Turbine ❑Reciprocating ❑Jet ❑
ABANDONED WELLS
Does property have any not in use and not sealed well(s)? ❑Yes Zq No
VARIANCE
Was a variance granted from the MDH for this well? ❑Yes [!No TN#
WELL CONTRACTOR CERTIFICATION
This well was drilled under my supervision and in accordance with Minnesota Rules,chapter 4725.
The information contained in this report is true to the best of my knowledge.
Use a second sheet,if needed.
REMARKS,ELEVATION,SOURCE OF DATA,etc.
Don Stodola Well Drilling 1691
Licensee Business Name Lic.or Reg.No.
"Air, 558 9/2/21
Certs led"epre.sentifiVe Signa ure f Certified Rep.No. Date
Rob Stodola
LOCAL COPY 857 012
Name of Driller
ID#52603 HE-01205-18(Rev.3/19)